A Casebook of Medical Ethics

Terrence F. Ackerman and Carson Strong

A Casebook of Medical Ethics

Terrence F. Ackerman and Carson Strong

Description

Should a brain-dead woman be artificially maintained for the sake of her fetus? Does a physician have the right to administer a life-saving transfusion despite the patient's religious beliefs? Can a family request a hysterectomy for their retarded daughter? Physicians are facing moral dilemmas with increasing frequency. But how should these delicate questions be resolved and by whom? A Casebook of Medical Ethics offers a real-life view of the central issue involved in clinical medical ethics. Since the analysis of cases plays a critical role in this study, the authors have assembled a broad collection of histories encountered in their work as medical ethics educators and consultants. The cases are developed in substantial detail to reflect the rich medical and psychosocial complexity involved, and each is brought to a decision point at which a course of action must be chosen. Among the issues examined are conflicts between patients' wishes and respect for their well-being, tensions concerning duties to patients unable to care for themselves and obligations to family members, and clashes between patient care obligations and the interests of other persons, including physicians, third parties, and the general public. The book also includes commentaries that combine general discussion of ethical principles with specific analysis of the cases examined in the text, as well as various options for resolving conflicts. Readers are invited to assess the comparative merits and liabilities of these approaches. An ideal text for undergraduate and medical school courses, A Casebook of Medical Ethics brings readers to the forefront of medicine, where they share in the determination of crucial ethical decisions.

A Casebook of Medical Ethics

Terrence F. Ackerman and Carson Strong

Table of Contents

1. Paternalism in the Therapeutic Relationship1.1. Ambivalence Toward Electroconvulsive Therapy1.2. Treatment Refusal in the Medical Intensive Care Unit1.3. An Uncooperative Leukemia Patient1.4. Rehabilitation of a Dependent Patient1.5. Alternative Approaches to Informed Consent1.6. Previous Refusal of Treatment by a Presently Comatose Patient1.7. A Family's Refusal of Blood Transfusions for a Mother and Her Son1.8. Deciding Whether to Discharge a Suicidal Patient1.9. A Request for Sex-Reassigning Surgery1.10. Divulging Information Concerning an Infant's Condition2. Duties to Patient and Family2.1. A Daughter's Insistence on Aggressive Treatment2.2. Parental Refusal of Cancer Treatment on Religious Grounds2.3. Informed Consent and the Dying Adolescent2.4. Treatment Refusal for an Infant with Possible Brain Damage2.5. Venereal Disease and Adolescent Confidentiality2.6. Contraceptives for an Adolescent2.7. Request for Abortion for a Retarded Daughter2.8. Request for Hysterectomy for a Retarded Eleven-Year-Old2.9. Conflict About Maintaining a Brain-Dead Woman for the Sake of Her Fetus2.10. Choosing the Method of Delivery for a Fetus with Hydrocephalus3. Deciding for Others3.1. A Bedridden and Cognitively Impaired Elderly Patient3.2. Who Should Decide for a Patient in Persistent Vegetative State?3.3. Nasogastric Tube Feedings for an Elderly Stroke Patient3.4. A Prolonged Stay in the Neonatal ICU3.5. Deciding Treatment When the Preliminary Diagnosis is Trisomy 183.6. Risk/Benefit Assessment of Surgery for a Child Suffering from Strokes3.7. Responding to a Family's Decision for Laetrile3.8. Selecting Therapy for a Mentally Retarded Teenager3.9. Birth Control for a Retarded Woman3.10. A Family's Lack of Commitment4. Medical Research Involving Human Subjects4.1. Limited Consent in Alcoholism Research4.2. Disclosure of Preliminary Results in a Randomized Clinical Trial4.3. Constraints on Consent in a Phase I Clinical Trial4.4. Proxy Consent for Incompetent Trauma Patients4.5. Undue Inducement in the Recruitment of Research Subjects4.6. Nontherapeutic Research Procedures Involving Children4.7. Discomfort from Repeated Nontherapeutic Research Procedures Involving Competent Adults4.8. Physicians' Treatment Preferences and Recruitment of Subjects for a Randomized Clinical Trial4.9. Parental Preferences and a Child's Involvement in a Randomized Clinical Trial4.10. Compensating Research Injuries5. Physicians, Third Parties, and Society5.1. Request for Surgery the Physician Considers Unnecessary5.2. Providing Free Care5.3. Risk of Litigation as a Factor in Decision Making5.4. Pressures to Provide Customary Care5.5. Confidentiality and Child Abuse5.6. Rejection of a Consultant's Advice5.7. Abortion Resulting in a Live Birth5.8. Costly Nutrition for a Terminal Patient5.9. Cost Factors in the Choice of Treatment for Kidney Stone Disease5.10. Artificial Insemination for a Single WomanTopical Index to Cases

A Casebook of Medical Ethics

Terrence F. Ackerman and Carson Strong

Author Information

Terrence F. Ackerman, Ph.D., is Professor and Chairman, Department of Human Values and Ethics, College of Medicine, University of Tennessee, Memphis. He is co-editor of Clinical Medical Ethics: Exploration and Assessment (University Press of America, 1987). Carson Strong, Ph.D., is Associate Professor in the Department of Human Values and Ethics, College of Medicine, University of Tennessee, Memphis.